Extensor tendonitis: Causes, symptoms, and treatment

extensor tendonitisExtensor tendonitis of the foot refers to inflammation of the tendon that resides within. Tendons are flexible but inelastic cords of strong fibrous collagen tissue that attach muscles to bone. In some cases, they can become inflamed, leading to tendonitis.

The reason you can extend your toes upward is because of the extensor hallucis longus muscle, which runs down from the knee to the ankle and over the top of the foot, then divides into two parts. One part is attached to the big toe, while the other is attached to the tips of the remaining toes of the foot. The tendon found in the foot is responsible for helping us pull the toes upward, called toe extensions.


Extensor tendonitis is a painful medical condition that can occur in individuals who are physically active or are involved in sports such as running, hiking, or cycling.

Causes of extensor tendonitis

Because of the extensor tendon foot location and the fact that a lot of stress is put on our feet daily, injury to this region is bound to happen. The overuse of muscles, bones, and tendons in the feet can occur for many reasons but typically involves spending a lot of time on your feet, wearing tight shoes, and using inappropriate footwear for a particular sport or activity. The following are some of the most common examples for how some individuals develop extensor tendinitis.

  • Poorly fitting shoes: Extended periods of increased pressure on top of the foot can compress the extensor tendon, leading to inflammation and pain development.
  • Tight shoelace: Tying your shoes too tight can put excessive amounts of pressure on top of the extensor tendon, leading to the development of extensor tendonitis.
  • Altered biomechanics of the foot: Legs and feet move in a particular way that is most comfortable for us. If this were to become altered, leading to movement dysfunction, it can result in multiple types of foot pain including extensor tendonitis.
  • Calf tenderness: Acute cramps, delayed onset muscle soreness (DOMS), and deep vein thrombosis (DVT), can be a source of calf tenderness. This may lead to chronic calf muscle tightness, resulting in tendonitis.
  • High foot arch or flat feet: Can lead to metatarsal or foot bone stress, leading to the development of inflamed tendons. This is generally referred to a metatarsal tendonitis.

Symptoms of extensor tendonitis

Common extensor tendon inflammation symptoms include:

  • Pain on the top of foot – the hallmark symptom of extensor tendonitis
  • Worsening pain with activity
  • Swelling on the top of foot
  • Possible bruising
  • Tenderness
  • Pain upon passive stretching of the tendons
  • Difficulty walking
  • Increased pain upon wearing tight-fitting shoes

Diagnosis of extensor tendonitis

Your doctor will first ask you when your foot pain started and how it presents. It is important to explain your symptoms in as much detail as possible. Telling your doctor about any recent injuries and changes in physical activity habits will help.

Next, your doctor will visually inspect your foot, looking for any signs of inflammation and swelling as well as signs of acute injury. This will give them a better idea of what kind of injury has occurred and what the next steps will be.

Once the physical exam has concluded, imaging tests may be done. If your doctor suspects a fracture, an X-ray will be ordered. For a more detailed look at the structures of the foot, an MRI may be ordered, which can give a better image of the tendons, muscles, and other soft tissue.

Treatment for extensor tendonitis

Extensor tendonitis treatment is focused on reducing irritation, inflammation, and pain. The following are the most
common therapies:

  • Rest: It is important to stop all aggravating activities that may have brought on the tendinitis to begin with. This will help promote healing and reduce extensor tendonitis recovery time.
  • Ice: A common treatment for the reduction of pain and inflammation. Ice is also a great option for reducing swelling of the foot by constricting capillaries.
  • Heat: Helps to dilate blood vessels and reduce pain. Having increased blood flow to the affected area promotes healing and a speedy recovery. Heat can be used in tandem to increase flow.
  • Exercises: The strength and endurance of the extensor muscles can be achieved by performing extensor tendonitis stretches. These typically focus on the calf muscles, as having tight calves can put more strain on the extensor tendons.
  • Medications: Over-the-counter medications like NSAIDs (non-steroidal anti-inflammatory drugs) work great at reducing pain and inflammation. Common NSAIDs include ibuprofen and naproxen.
  • Orthotics: Providing extra support to the foot helps to reduce stress on the bones, tendons, and muscles of the foot. These commonly come in the form of custom shoe inserts.
  • Physical therapy: Involves performing stretches and exercises that promote strength and endurance. Physical therapy helps to relieve tightness in the tendons, feet, and calf muscles.
  • Steroid injections: If all other options for pain relief have failed, your doctor may recommend getting steroid injections. This is the most effective method for pain and inflammation treatment, however, it can weaken the tendon over time if used repeatedly.
  • Massage: Can improve blood flow to the affected area, promoting the healing process. While not scientifically proven, many tendonitis sufferers say that gentle massage helps to reduce pain.

Prevention for extensor tendonitis


You stand on your feet every day, so it makes sense to provide them with the best support you can afford. It is also recommended to wear shoes that match your activity. For example, if you are going hiking, a good pair of hiking shoes is recommended to provide support on uneven terrain. Also, if you feel the pain in your foot during any activity, no matter the level of intensity, stop and rest as your body is telling you that you may hurt yourself if you go any further.

Recovery period for extensor tendonitis

Recovery will depend on the severity of extensor tendonitis and how well it is treated. Not avoiding the initial trigger for the condition will prolong recovery periods or even lead to further complications. It is important to take the time to allow yourself to recover and utilize the various treatment for the condition. If you find that your particular case of foot pain is not resolving, seeing your local physician will provide you with more information and potential new treatment options.

Related: Outside foot pain: Causes, symptoms, treatment, and exercise tips

Author Bio

Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. She is a registered Zumba instructor, as well as a Canfit Pro trainer, who teaches fitness classes on a weekly basis. Emily practices healthy habits in her own life as well as helps others with their own personal health goals. Emily joined Bel Marra Health as a health writer in 2013.



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